In a typical suturing procedure, the suture needle is manipulated through either the skin or underlying tissue of a laceration, by use of a surgical needle holder. With the needle secured in the jaws of the needle holder, the needle holder serves to guide the needle, causing the needle to pierce the skin adjacent the laceration, so that the edges of the laceration may be drawn together by the suturing thread which is bonded to the needle. In this manner, the thread serves to close the laceration and the thread is then tied by a surgeon's knot. With interrupted suturing, the suture thread is cut after each suture, so that the sutures are physically separate from one another.
Suturing of simple lacerations, particularly lacerations of the face and hands, comprise a substantial proportion of patients seen in emergency departments, urgent care centers and family practitioner's offices. Lacerations of this type usually require one or two layers of sutures for adequate repair, and the typical laceration usually has a length of 0.5 to 5.0 cm.
The physician suturing a simple laceration works without an assistant, and accordingly, the suturing procedure is tedious, redundant, and time-consuming. By contrast, in the operating room setting, an assistant will pass instruments, cut sutures in rhythm with their placement, retract wound edges, and perform other small, but time-consuming tasks.
In the usual sequence of suturing a simple laceration, the curved needle is clamped by the needle holder held in one hand by the surgeon, and the needle with thread attached is passed through both wound edges. The needle, after passing through the wound edges is then grasped either with the surgeon's fingers or a forceps and held in the opposite hand. The needle holder is then used to tie the surgeon's knot, and the suture is then cut. In the normal procedure, it is necessary for the surgeon to place the needle holder on the instrument tray and pick up the scissors in order to cut the suture. After cutting the suture, the scissors are placed back on the tray and the needle holder again picked up and the suturing process repeated. A simple cm laceration often requires a number of sutures, and if the wound is deep, it may also include the placement of buried absorbable sutures prior to placement of the skin sutures. Thus, even when suturing minor lacerations, multiple picking up and putting down of instruments is required. This not only is time consuming, but creates a measure of distraction for the surgeon from the performance of the surgical process.
As a further problem, the continual picking up and putting down of instruments on the surgical tray presents opportunities for possible injury to the surgeon due to accidental cuts or needle sticks. This is of major importance in accidental transmission of certain blood-borne diseases.
In an attempt to avoid the sequences of instrument transfers, it has been proposed to utilize an instrument which combines both a needle holder and scissors, such as shown in U.S. Pat. No. 2,315,326. In the instrument as disclosed in that patent, a pair of opposing clamping jaw surfaces are provided at the distal end of each arm of the instrument and working surfaces shaped as a pair of blades are located between the clamping jaws and the pivot axis of the arms.
A combined needle holder and scissors of that type has certain drawbacks. As the scissor blades are located inwardly from the distal end of the arms of the instrument, it obscures the surgeon's view of cutting. As a further disadvantage, the scissors can only be used for cutting the suture thread and cannot normally be used for trimming tissue and debriding small bits of a wound. In addition, with the scissors located inwardly of the clamping jaws, no scissor points or tips define the scissors, so that it is difficult for the surgeon to precisely locate the scissor blades.
It has also been proposed in the past to design a combined needle holder and scissors with a third arm, as shown in U.S. Pat. 4,452,246. In this construction, the third arm contains a scissors blade which operates against the outer edge of the needle holder to provide a cutting function. However, instruments of this type, incorporating a third arm, are more costly to produce and are more cumbersome and difficult to manipulate.